Provider Demographics
NPI:1750379863
Name:WOMBLE, JOHN S (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:WOMBLE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2300 MANCHESTER EXPY STE 2001A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-6802
Mailing Address - Country:US
Mailing Address - Phone:706-320-3126
Mailing Address - Fax:706-320-3054
Practice Address - Street 1:610 19TH STREET
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1528
Practice Address - Country:US
Practice Address - Phone:706-322-7884
Practice Address - Fax:706-660-2171
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2024-08-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA044866207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52738836003OtherBCBS
P00160093OtherRAILROAD MEDICARE
450491390W9M1OtherEVERGREEN
0100156OtherUNITED HEALTHCARE
2554240OtherCIGNA
AL60027776OtherBCBS
GA000818419GMedicaid
1813747OtherFIRST HEALTH
GA000818419LMedicaid
GA000818419GMedicaid
GA511I080710Medicare PIN
1813747OtherFIRST HEALTH